South Africa's Obesity Epidemic Requires Medical Response, Not Stigma, Experts Warn

SOUTH AFRICA’S OBESITY CRISIS DEMANDS MEDICAL INTERVENTION, NOT MORAL JUDGMENT, SURGEON SAYS

More than half of South Africa’s population is overweight or obese, according to the Association for Diabetics in South Africa (ADSA), placing the country among the worst-affected nations on the continent. The condition affects 68 percent of women and 31 percent of men, while children’s rates remain among the highest in Africa. Yet widespread misconceptions continue to block patients from accessing treatment, a leading bariatric surgeon warns.

The economic toll is substantial. ADSA estimates obesity costs the country more than R33 billion annually in direct healthcare expenditure alone. Beyond finances, the condition drives a significant portion of South Africa’s non-communicable disease burden, fueling type 2 diabetes, hypertension and cardiovascular disease across the population.

Dr Nkosikhona Mlimi, a bariatric and laparoscopic surgeon at Mediclinic Medforum in Arcadia, argues that obesity remains profoundly misunderstood despite growing public awareness. Myths and stigma surrounding the condition prevent many people from seeking the medical help they need.

“Obesity is not a personal failure. It is a medical condition that deserves the same compassion, understanding, and treatment as any other chronic disease. No one should suffer in silence or feel ashamed to seek help. Effective treatment options are available, and with the right support, patients can achieve meaningful improvements in their health, confidence, and quality of life,” Mlimi says.

One persistent myth holds that obesity results simply from laziness. In reality, the condition is complex, shaped by genetics, hormones, metabolism, environmental factors, medications and lifestyle choices. Willpower alone cannot overcome these biological forces.

Another common misconception suggests that eating less and exercising more will solve obesity for everyone. While healthy eating and physical activity matter, many patients face biological obstacles that make sustained weight loss extremely difficult without medical or surgical intervention.

Bariatric surgery itself is frequently mischaracterized. Some view it as an easy shortcut, but the procedure is a major medical intervention demanding significant commitment, lifestyle changes, nutritional management and ongoing follow-up care. It functions as a tool to help patients achieve and maintain healthier lives, not a quick fix.

The surgery’s benefits extend well beyond weight loss. It can significantly improve or even resolve type 2 diabetes, hypertension, sleep apnoea, fatty liver disease and obesity-related joint problems. Contrary to the belief that obesity merely affects appearance, it touches nearly every organ system in the body and can shorten life expectancy if left untreated.

Determining who qualifies for bariatric surgery involves specific medical criteria. Patients with a body mass index of 35 or higher who have experienced repeated unsuccessful weight-loss attempts and are living with obesity-related complications affecting their health and quality of life may be appropriate candidates.

Mlimi encourages individuals struggling with obesity despite sustained efforts at diet and exercise to consult their healthcare provider about available treatment options. “Your journey to better health starts with a conversation,” he says. Whether South Africa’s healthcare system can meet that demand at scale, given a R33 billion annual burden already straining resources, remains the harder question.